All of you who hold celebrations – barbecues, pizza lunches, awards ceremonies – to recognize employees’ efforts to reduce personal injuries and illnesses, raise your hands.
Now, ask yourselves this: Is our focus on reducing minor injuries causing us to ignore or overlook situations that could lead to catastrophic consequences?
A white paper released in 2011 by Behavioral Science Technology Inc. (BST) and based on a study conducted by BST and Mercer ORC Networks points out that while the overall occupational recordable injury rate has declined in recent years, serious injuries and fatalities have not declined at the same rate. In fact, they have held steady or even have increased.
According to BST, reducing non-serious injuries does not equal a reduction in serious or fatal injuries for two reasons: First, the causes and variables of the less-serious injuries are not always the same as the causes and variables associated with the fatal or serious injuries. Second, most non-serious injuries present a low potential for fatalities or serious injuries.
Two relatively recent disasters bring this point home.
In its investigation of the Macondo Deepwater Horizon disaster, the Chemical Safety Board (CSB) found that BP and its contracted drilling rig operator, Transocean, were focused on personal safety issues such as worker injury rates, rather than broader process safety management issues. Noting the lack of sustained focus on process safety, CSB Investigator Cheryl MacKenzie described an “eerie resemblance” between the 2005 explosion at the BP Texas City refinery and the explosion aboard the Deepwater Horizon.
At the BP Texas City refinery on March 23, 2005, contract workers had just returned to temporary trailers at the plant after attending a celebratory lunch commending an excellent personal injury accident record. Shortly after lunch, an explosion occurred during process startup, killing 15 and injuring 180 others.
At Macondo, BP and Transocean officials lauded operators and workers for a low rate of personal injuries on the very day of that tragedy. Company VIPs had flown to the rig in part to commend the work force for zero lost-time incidents.
“The emphasis on personal injury and lost work-time data obscures the bigger picture: that companies need to develop indicators that give them realistic information about their potential for catastrophic accidents,” said MacKenzie. “How safety is measured and managed is at the very core of accident prevention. If companies are not measuring safety performance effectively and using those data to continuously improve, they will likely be left in the dark about their safety risks.”
Traditionally, safety professionals have turned to Heinrich’s Safety Triangle for guidance. The triangle assumes that as injuries increase in severity, their numbers decease in frequency; all injuries of low severity have the same potential for serious injury; injuries of different severities have the same underlying causes; and one injury reduction strategy can affect all types of injuries equally.
According to BST’s white paper, such thinking also may encourage companies to place “disproportionate emphasis on less serious injuries to the detriment of more serious ones.”
Experts Suggest...
Experts suggest that rather than relying on injury numbers to determine if your workplace is safe, make sure you have the following in place:
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Comprehensive hazard assessments and systems. BP and Transocean hazard assessment systems were inadequate. For example, the bridging document that sought to harmonize safety controls between BP and Transocean was a minimal document that focused only on six personal safety issues such as minimum heights for employing fall protection equipment.
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Processes to deal with emergency situations. Hazard assessments of major accident risks on the Deepwater Horizon relied heavily on prompt, correct manual intervention by the rig crew to prevent a catastrophe. Depending on a human reaction alone during an emergency situation – with many distractions – is not a reliable safety layer.
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Written procedures for tasks ranging from routine maintenance to lockout/tagout to machine restarts to tank cleaning to ensure uniform safety performance.
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Appropriate systems for managing the safety of process changes. Document management of change procedures and formal hazard assessments.
- A process to investigate safety incidents and near misses. Implement change based on those investigations and communicate results to employees.